European Spine Journal最新文献

{"title":"SATB2 promotes osteogenic differentiation of OPLL-derived posterior longitudinal ligament cells via Wnt/β-catenin signaling in association with RUNX2.","authors":"Chang Zhou, Weifeng Hu, Jinglong Yan, Anlong Jiang","doi":"10.1007/s00586-026-10430-4","DOIUrl":"https://doi.org/10.1007/s00586-026-10430-4","url":null,"abstract":"<p><strong>Background: </strong>Ossification of the posterior longitudinal ligament (OPLL) is a prevalent pathological condition characterized by ectopic ossification of spinal ligaments, leading to myelopathy through spinal cord compression. SATB2 is a multifunctional regulator of osteogenic differentiation, and prior studies in other osteogenic systems have suggested links between SATB2, RUNX2, and Wnt/β-catenin signaling [1, 2]; however, whether these regulatory relationships operate in OPLL-derived posterior longitudinal ligament cells (OPLL cells) remains incompletely understood. In this study, we investigated the role of SATB2 in osteogenic differentiation by examining the contribution of RUNX2 and associated changes in Wnt/β-catenin signaling. Our data support that, in OPLL cells, SATB2 overexpression is associated with Wnt/β-catenin-related signaling changes, increased RUNX2 expression, and enhanced osteogenic differentiation of OPLL cells.</p><p><strong>Methods: </strong>OPLL cells were transfected with a SATB2-overexpressing plasmid and subjected to osteogenic induction. ALP staining and Alizarin Red S staining were used to assess osteogenic differentiation. RT-qPCR, Western blotting and immunofluorescence were performed to evaluate osteogenic markers and Wnt/β-catenin-related factors. TOPFlash reporter assays were used to assess β-catenin/TCF transcriptional activity. XAV939 was used to inhibit Wnt/β-catenin signaling, and RUNX2 was silenced using siRNA. For the dose-comparison experiment, OPLL cells were treated with XAV939 at final concentrations of 5 or 10 µM. The 10 µM concentration was used for the Western blot experiment and subsequent pathway-inhibition experiments. Co-immunoprecipitation was performed to examine the association between SATB2 and RUNX2 proteins.</p><p><strong>Results: </strong>SATB2 overexpression was associated with increased total β-catenin expression, reduced phosphorylated β-catenin and DKK1 expression, and increased TOPFlash reporter activity. In contrast to the expected response of a canonical β-catenin/TCF target gene, AXIN2 expression was unexpectedly reduced after SATB2 overexpression. Thus, while the β-catenin and TOPFlash findings were consistent with enhanced β-catenin/TCF transcriptional activity, the AXIN2 response was discordant with the classical feedback pattern of canonical Wnt signaling. RUNX2 knockdown attenuated the SATB2-associated activation of Wnt/β-catenin signaling and osteogenic differentiation. In XAV939-treated cells, SATB2 overexpression partially attenuated the inhibitory effect of Wnt pathway blockade on osteogenic marker expression. Co-immunoprecipitation showed that SATB2 and RUNX2 were present in the same protein complex in OPLL cells. We isolated cells from the posterior longitudinal ligament at sites close to the ossification border and the center of the non‑ossified region in OPLL patients, and induced osteogenic differentiation. No statistically significant differences were","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excessive intraoperative diastolic blood pressure decrease during anesthesia lead to a higher risk of postoperative hematoma following anterior cervical discectomy and fusion (ACDF): a single-center study of 10,615 patients.","authors":"Jiyan Jin, Ruomu Qu, Ben Wang, Haoxiang Wang, Ziqi Yi, Feifei Zhou","doi":"10.1007/s00586-026-10387-4","DOIUrl":"https://doi.org/10.1007/s00586-026-10387-4","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative hematoma (PH) after anterior cervical discectomy and fusion (ACDF) is a serious complication that requires urgent intervention. Many surgeons prefer maintaining relatively low blood pressure during surgery to minimize blood loss; however, the effect of this practice on the risk of PH remains unclear. This study aims to investigate how perioperative blood pressure management influences the risk of PH following ACDF.</p><p><strong>Methods: </strong>We reviewed consecutive patients who underwent ACDF at a single institution from January 2010 to December 2021. Patients who developed postoperative hematoma (PH) were classified as the hematoma group. For each PH patient, three control subjects who underwent same surgery within the adjacent month were randomly selected, forming a control group. Potential risk factors were collected, including demographic data, comorbidities, surgical characteristics, coagulation function, and perioperative blood pressure. Univariate and multivariable analyses were conducted to identify risk factors for PH.</p><p><strong>Results: </strong>Among 10,615 ACDF cases, 26 (0.24%) developed PH. All patients underwent hematoma evacuation, and most experienced symptom relief after surgery, except for one patient who unfortunately died from ischemic hypoxic encephalopathy. The PH group exhibited significantly higher preoperative diastolic blood pressure (DBP), pulse rate, and a more pronounced decrease in intraoperative DBP. Multivariable analysis indicated that a greater intraoperative decrease in DBP is an independent risk factor for PH. The area under curve was 0.695, and the cut-off value of DBP decrease was 19.5 mmHg.</p><p><strong>Conclusion: </strong>Excessive intraoperative DBP decrease might be associated with higher risk of PH after ACDF. We recommend limiting intraoperative DBP decreases to 19.5 mmHg to mitigate this risk.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline history of primary fragility fracture is associated with medical complications and revision through 1 year in adult spinal deformity patients undergoing thoracolumbar spinal fusion.","authors":"Neil V Shah, Rachel Baum, Alejandro J Friedman, Chibuokem P Ikwuazom, Rehan R Khan, Alex La Poche, Stefani Manis, Dario Fucich, Juhayer S Alam, Kyle Smith, Henna Purewal, Prasenjit Saha, Jad Bou Monsef, Chadi Tannoury, Tony Tannoury, Carl B Paulino","doi":"10.1007/s00586-026-10417-1","DOIUrl":"https://doi.org/10.1007/s00586-026-10417-1","url":null,"abstract":"<p><strong>Purpose: </strong>Fragility fractures (FFx) can indicate osteoporosis following posterior spinal fusion (PSF) in adult spinal deformity (ASD) patients. We sought to evaluate the impact of a history of FFx on adverse postoperative outcomes following ≥ 3-level PSFs.</p><p><strong>Methods: </strong>This retrospective cohort study queried the Mariner10 PearlDiver database to identify patients aged ≥ 50 years undergoing ≥ 3-level PSF for ASD from 2010 to 2022. All trauma, infection, and tumor indications were excluded. Patients with and without a history of FFx (hip, proximal humerus, distal radius, vertebral body, or pelvis fracture) were stratified. Multivariable logistic regression identified factors associated with adverse outcomes (covariates: age, sex, CCI, obesity, FFx history).</p><p><strong>Results: </strong>439 ASD patients were identified, of which 33 (7.5%) had FFx. These patients had higher overall medical complications (38.3% vs. 5.2%), respiratory failure (8.3% vs. 2%), DVT (8.3% vs. 0.6%), and infection (6.7% v 0.9%) at 90-day postoperatively, all p < 0.05. FFx patients had higher surgical complications (20% vs. 2.5%), revision/extension (15% vs. 0.4%), and decompression/laminectomy (6.7% vs. 0.8%) at 1-year, all p < 0.005. FFx history was associated with higher risk of wound disruption (OR = 3.9), respiratory failure (OR = 3.1), pneumonia (OR = 2.4), and PE (OR = 1.1). FFx history was associated with higher odds of revision/extension (OR = 3.5), all p < 0.05.</p><p><strong>Conclusions: </strong>FFx history was associated with both medical and surgical complications through 1-year postoperatively, demonstrating how important risk stratification/optimization data can be identified from simple preoperative assessment of FFx history.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative disability is independently associated with postoperative care intensity following anterior cervical discectomy and fusion.","authors":"Bruno Verna, Keanu Shah, Tom Folkerts, Pedro Rocha Torres, Steven M Maurer, Anna-Maria Mielke, Julia Wimmer, Roland Duculan, Jennifer Shue, Marco D Burkhard, Andrew A Sama, Frank P Cammisa, Federico P Girardi, Carol A Mancuso, Alexander P Hughes","doi":"10.1007/s00586-026-10423-3","DOIUrl":"https://doi.org/10.1007/s00586-026-10423-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Postoperative outcomes following anterior cervical discectomy and fusion (ACDF) are traditionally assessed using complications or long-term patient-reported outcomes (PROMs). However, determinants of immediate postoperative recovery and in-hospital resource utilization remain less well defined. This is particularly relevant with the increasing adoption of outpatient ACDF pathways, where accurate preoperative risk stratification is critical. The objective of this study was to evaluate whether preoperative PROMs are associated with postoperative care intensity following ACDF, in addition to established surgical factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a retrospective analysis of a prospectively collected cohort of patients undergoing ACDF for degenerative pathology. Both primary and revision ACDF procedures were eligible, while hybrid constructs, posterior procedures, cervical disc arthroplasty, and other non-ACDF operations were excluded. A composite postoperative care intensity score (0-3) was defined as the primary outcome, reflecting in-hospital recovery burden based on: (1) prolonged length of stay (LOS ≥ 2 days), (2) delayed extubation, and (3) stepdown/orthopedic special care unit (OSCU) admission. A sensitivity analysis used a stricter LOS definition (≥ 3 days). Multivariable Poisson regression was used to evaluate associations between preoperative variables, including Neck Disability Index (NDI), expectations score, PHQ-8, and postoperative care intensity, adjusting for age, operative duration, revision status, and number of levels fused.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 333 patients, 299 were included in the multivariable analysis. Increasing number of fused levels was independently associated with greater postoperative care intensity (incidence rate ratio [IRR] 1.54 per level, p &lt; 0.001). Higher preoperative disability (NDI) was independently associated with increased care intensity (IRR 1.11 per 10 points, p = 0.018). Age was also independently associated with increased care intensity (IRR 1.20 per 10 years, p = 0.011). Operative duration, revision status, patient expectations, and PHQ-8 scores were not significantly associated with the outcome. In sensitivity analysis (LOS ≥ 3 days), number of fused levels (IRR 1.88, p &lt; 0.001), age (IRR 1.37 per 10 years, p = 0.002), operative duration (IRR 1.06 per 30 min, p = 0.042), and NDI (IRR 1.13 per 10 points, p = 0.041) remained significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;While surgical complexity was consistently associated with postoperative care needs following ACDF, preoperative disability was independently associated with increased postoperative care intensity, even after accounting for operative factors. In contrast, patient expectations and depressive symptoms were not associated with early postoperative resource utilization. These findings suggest that immediate postoperative recovery is influenced by baseline functional status in additi","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital twin validation and predictive value of delta radiomics based on tabular transformer for synergistic muscle imbalance in lumbar disc degeneration.","authors":"Baichuan Mu, Zhe Fan, Yinzhong Chen, Jingguo Wu","doi":"10.1007/s00586-026-10383-8","DOIUrl":"https://doi.org/10.1007/s00586-026-10383-8","url":null,"abstract":"<p><strong>Background: </strong>Current methods struggle to quantify muscle synergistic imbalance and nonlinear interactions in Lumbar Intervertebral Disc Degeneration (LIDD). This study proposes a novel strategy combining \"Delta Radiomics\" with a Tabular Transformer deep learning architecture, aiming to improve the precision of early risk assessment.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on L4-L5 MRI images from 663 subjects. Texture features of the Psoas Major (PM) and Erector Spinae (ES) were extracted, and (PM-ES)/ES was calculated as the \"Delta Feature\" to eliminate individual variation. An in silico digital twin simulation system was constructed to validate the physical sensitivity of these features. The predictive performance of the nonlinear Tabular Transformer model was compared with a traditional logistic regression model.</p><p><strong>Results: </strong>In silico experiments confirmed that Delta features possess superior \"common-mode noise rejection\" capabilities. In the early stage of degeneration (Step 20), when original features showed only weak changes, Delta features detected highly significant inter-group differences (P < 0.001). In the independent test set, the Tabular Transformer model demonstrated the best discriminative power with an AUC of 0.848 (95% CI: 0.781-0.916), outperforming the Combined linear model utilizing the same features (AUC = 0.804, P = 0.089) and single-modality models. Although the raw AUC improvement was marginal, Decision Curve Analysis (DCA) and quantitative calibration (Brier score = 0.145) showed that the Transformer model offered higher net clinical benefit and superior absolute risk estimation across a wider threshold range. Additionally, SHAP analysis revealed that the core features identified by the model highly aligned with the biomechanical compensation failure mechanisms set in the simulation, validating the model's decision logic.</p><p><strong>Conclusion: </strong>Delta radiomics can sensitively capture microscopic muscle imbalance. Combined with the nonlinear modeling advantages of the Tabular Transformer architecture, this approach provides an objective, interpretable, and quantitative basis for the early non-invasive diagnosis and risk stratification of LIDD.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parity, menopausal timing, and spinopelvic mismatch: a moderated mediation analysis of low back pain in postmenopausal women.","authors":"Seda Altun, Ozan Altun, Rukiye Aysu Revanlı Saygılı, Uygar Daşar, Murat Bozkurt, Nuray Bozkurt","doi":"10.1007/s00586-026-10408-2","DOIUrl":"https://doi.org/10.1007/s00586-026-10408-2","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the association of parity and menopausal timing with spinopelvic alignment in postmenopausal women and whether pelvic incidence-lumbar lordosis (PI-LL) difference statistically mediates the association between parity and low back pain.</p><p><strong>Methods: </strong>This single-centre cross-sectional study included 239 postmenopausal women aged ≥ 45 years. Standardised standing lumbosacral radiographs were used to measure pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, and PI-LL difference. PI-LL mismatch was defined as ≥ 10°. Pain severity was assessed using a visual analogue scale. Multivariable regression and mediation analyses were performed.</p><p><strong>Results: </strong>Higher parity was associated with greater pelvic incidence, sacral slope, and PI-LL difference. Pelvic incidence differed significantly across parity groups (nulliparous, 1-2 deliveries, and ≥ 3 deliveries) (H(2) = 30.163, p < 0.001), with median values of 43.80° (40.30-47.50) in nulliparous women and 48.35° (44.80-51.30) in women with ≥ 3 deliveries. Earlier menopausal age was associated with greater PI-LL difference. PI-LL mismatch was present in 25.5% of women and was associated with higher pain severity (p < 0.001).</p><p><strong>Conclusion: </strong>Higher parity and earlier menopausal age were associated with differences in measured spinopelvic parameters, particularly PI-LL difference. Reproductive history and menopausal timing may be clinically relevant when interpreting low back pain in postmenopausal women.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predurotomy intraoperative ultrasound in intradural extramedullary spinal tumor surgery: agreement with preoperative magnetic resonance imaging and correlation with microsurgical findings.","authors":"Fernando García Pérez, Mario Gomar Alba, José Javier Guil Ibáñez, Gracia María Castro de Luna, Antonio Huete Allut, Antonio José Vargas López","doi":"10.1007/s00586-026-10415-3","DOIUrl":"https://doi.org/10.1007/s00586-026-10415-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Intraoperative ultrasound (IOUS) has been widely used in spinal tumor surgery. However, this imaging modality is highly operator-dependent and the available evidence regarding its applications in this field is derived predominantly from descriptive studies, while studies systematically assessing its agreement with magnetic resonance imaging (MRI) or its correlation with microsurgical findings remain scarce. The present study provides an assessment of the agreement between predurotomy IOUS and preoperative MRI in intradural extramedullary (IDEM) spinal tumor surgery based on an interobserver comparative analysis of several anatomical structures that are consistently identifiable and reproducible in this setting. In addition, corresponding microsurgical images are presented, establishing an integrated MRI-IOUS-Microsurgery correlation framework that may be valuable for both neuroradiologists and neurosurgeons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective case series of patients with IDEM spinal tumors was compiled. Each case was characterised using a set of representative images depicting the same anatomical area of interest (tumor location), obtained by predurotomy IOUS, preoperative MRI and an operating microscope. Experienced neurosurgeons independently evaluated the IOUS images and MRI scans using a structured questionnaire and rated the perceived agreement on a 5-point scale by comparing several structures. Agreement between predurotomy IOUS and preoperative MRI was subsequently analysed. These structures were identified in an integrated MRI-IOUS-Microsurgery correlation framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nine patients with IDEM spinal tumors were included. A total of 768 agreement assessments were obtained, of which 579 (75.39%) were comparable. Tumor and spinal cord showed the highest levels of agreement between IOUS and MRI, followed by the subarachnoid space and dura mater, which also showed high, although somewhat lower, agreement. In contrast, pia mater and nerve roots showed the lowest levels of agreement. Compared with MRIT1c, MRIT2 demonstrated significantly higher agreement with IOUS for nerve roots, dura mater, pia mater and subarachnoid space, while there were no significant differences for tumor or spinal cord. Sagittal images achieved significantly higher agreement scores than axial images. Despite systematic differences in scoring among observers, interobserver reliability was good when ratings from four observers were averaged, with comparable reproducibility for IOUS-MRIT1c and IOUS-MRIT2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Taking interobserver variability into account, IOUS-MRI agreement varied according to the anatomical structure evaluated, being highest for tumor and spinal cord, followed by subarachnoid space and dura mater, and lowest for pia mater and nerve roots. Sagittal images provided superior anatomical orientation compared with axial images. Interobserver reproducibility","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The LL-TK index as a regional marker of sagittal balance and disability in adults with chronic low back pain.","authors":"Juliano Rodrigues Dos Santos, Claudio Piras, Guilherme Galito Henriques, Carlos Fernando Pereira da Silva Herrero, João Heitor Dal Bello Gonzales, Jefferson Soares Leal","doi":"10.1007/s00586-026-10426-0","DOIUrl":"https://doi.org/10.1007/s00586-026-10426-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Population aging has increased both the prevalence and clinical impact of adult spinal deformity (ASD). Sagittal and regional parameters (e.g., SVA, PI-LL, LL-TK) guide assessment and treatment planning, but it remains unclear which indices are most closely associated with sagittal imbalance and functional disability. This study therefore evaluated the associations between regional and global spinopelvic parameters and clinical status in an adult outpatient cohort with chronic low back pain, and compared the ability of the LL-TK and PI-LL indices to discriminate concurrent sagittal imbalance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Cross-sectional study including 142 patients (mean age 56.6 ± 13.2 years) with chronic low back pain, evaluated between 2018 and 2019. Standing full-length AP and lateral radiographs were analyzed using Surgimap to measure SVA, LL, TK, PI, PT and SS. Regional indices (LL-TK and PI-LL) were calculated. Patients were classified as balanced (SVA &lt; 4 cm) or unbalanced (SVA ≥ 4 cm). Pearson correlations, independent-samples t tests and ROC analysis were performed; significance threshold p &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean values were: ODI 23.6 ± 14.2; VAS 4.5 ± 2.3; LL 55.3° ± 13.0; TK 44.1° ± 13.8; PI 52.8° ± 10.9; PT 16° ± 9.0; SS 36.9° ± 9.0; PI-LL - 2.5° ± 12.8. SVA correlated significantly with age (r = 0.50), ODI (r = 0.40), VAS (r = 0.42), LL (r = - 0.28), LL-TK (r = - 0.43) and PI-LL (r = 0.42) (all p &lt; 0.001). LL-TK also demonstrated significant correlations with clinical and radiographic measures. Twenty-nine patients (20.4%) were sagittally unbalanced. For the identification of concurrent sagittal imbalance, ROC analysis yielded optimal cutoffs of 12° for LL-TK (AUC = 0.755; sensitivity 96.6%; specificity 55.8%) and 9° for PI-LL (AUC = 0.699; sensitivity 44.8%; specificity 86.7%); the AUC of LL-TK was numerically higher, but the two correlated curves were not compared statistically. The combined criterion LL-TK &gt; 12° and PI-LL ≤ 9° was met by 56 patients, of whom 55 (98%) had satisfactory sagittal alignment (SVA &lt; 4 cm). Conversely, LL-TK ≤ 12° combined with PI-LL &gt; 9° identified 14 patients, 11 (78%) of whom were sagittally unbalanced (positive predictive value 78%; negative predictive value of the favorable combination 98%). The remaining 72 patients (50.7%) had discordant index values and were not classified by this rule.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this cross-sectional cohort of adults with chronic low back pain, the regional LL-TK index was moderately associated with SVA and with patient-reported disability, and its AUC for discriminating sagittal malalignment was numerically higher than that of PI-LL; the two AUCs were not formally compared, so no superiority is claimed. The combination of regional and pelvic parameters yielded a high predictive values in the concordant subgroups, suggesting potential value as an adjunct screening aid rather than a basis for outcom","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing limitations of previous meta-analyses of uniportal versus biportal endoscopic lumbar surgery: an umbrella review and de-duplicated, pathology-stratified meta-analysis.","authors":"Rafael Lindi Sugino, Gabriel Pokorny, Jullyene Pokorny, Weby Mizael","doi":"10.1007/s00586-026-10375-8","DOIUrl":"https://doi.org/10.1007/s00586-026-10375-8","url":null,"abstract":"<p><strong>Purpose: </strong>Previous meta-analyses of uniportal versus biportal endoscopic lumbar surgery are affected by overlapping primary studies, discordant study-level extraction, and aggregation of pathologies requiring different operative tasks. We appraised the review-level evidence and generated a de-duplicated, pathology-stratified synthesis of operative time, complications, disability, and leg pain.</p><p><strong>Methods: </strong>Five databases were searched for systematic reviews. Primary citations were normalized across reviews, each eligible comparison was included once per outcome, and discordant group allocation, sample size, follow-up, and numerical values were checked against the original primary publication wherever accessible. Random-effects models and meta-regression examined pathology, approach, and country. Review quality, primary-study risk of bias, and certainty were assessed with AMSTAR 2, RoB 2 or the Newcastle-Ottawa Scale, and GRADE, respectively.</p><p><strong>Results: </strong>Five reviews and 35 analytic comparisons from 34 primary publications were included. Operative time did not differ overall (35 comparisons; 3,338 participants; MD, 0.09 min; 95% CI, - 8.29 to 8.47), but the direction differed by pathology (P < 0.001): the estimate favored shorter uniportal procedures for LDH (13 comparisons; MD, - 17.67 min; 95% CI, - 26.90 to - 8.44; I² = 92.6%) and shorter biportal procedures for LSS (22 comparisons; MD, 10.45 min; 95% CI, 0.73 to 20.17; I² = 98.9%). Complications (OR, 1.44; 95% CI, 0.94 to 2.23), ODI (MD, 1.96; 95% CI, - 0.60 to 4.52), and leg-pain VAS (MD, 0.01; 95% CI, - 0.05 to 0.06) did not differ clinically. Certainty was low to very low.</p><p><strong>Conclusion: </strong>De-duplication and pathology stratification showed that an overall null operative-time estimate may average effects in opposite directions. These findings support possible effect modification by pathology but, given substantial residual heterogeneity and low to very low certainty, do not establish the superiority of either technique for LDH or LSS.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One- to two-year outcomes after surgery for cervical myelopathy: a systematic review of symptom duration and baseline severity.","authors":"Elie Najjar, Ali Akil, Hussein Akil, Negin Nematiniaye Masooleh, Neel Badhe, Harris Mangal, Chinedu Egu, Rawan Masarwa, Khalid Salem, Nasir A Quraishi","doi":"10.1007/s00586-026-10412-6","DOIUrl":"https://doi.org/10.1007/s00586-026-10412-6","url":null,"abstract":"<p><strong>Background: </strong>Degenerative cervical myelopathy is a progressive cause of spinal cord dysfunction. While surgery is recommended for moderate, severe, or progressive disease, > 12 months recovery beyond the first postoperative year and the influence of symptom duration remain less clearly defined.</p><p><strong>Methods: </strong>A PRISMA-based systematic review was performed of surgical studies in degenerative cervical myelopathy reporting outcomes at 12 months or longer, with data on symptom duration, baseline severity, or recovery modifiers. Risk of bias was assessed using ROBINS-I. Comparable JOA/mJOA change scores were pooled as standardised mean changes using a random-effects model with Hartung-Knapp adjustment. Leave-one-out sensitivity analysis was performed.</p><p><strong>Results: </strong>Eight studies including 3,991 surgically treated patients met the inclusion criteria; 3,933 contributed > 12 months outcome data. The weighted mean age was 61.4 years, and 62.3% of patients were male. All studies were judged to be at overall moderate risk of bias. Three studies, comprising 1,218 patients, provided extractable JOA/mJOA change-score data. Random-effects meta-analysis showed a pooled neurological improvement of + 1.41 JOA/mJOA points (95% CI + 0.62 to + 2.19), with substantial heterogeneity (I² = 90.4%). Across the remaining studies, neurological improvement was consistently reported at 12 months or longer. Six studies found that longer symptom duration was associated with poorer recovery in at least one outcome domain, although reported thresholds varied from 4 months to more than 2 years. The effect of delayed surgery appeared more consistent for disability, physical function, quality of life, bladder function, and extremity-function outcomes than for JOA/mJOA alone. Evidence on baseline severity was limited to one study and suggested greater absolute neurological improvement in patients with more severe baseline myelopathy; this finding should be considered exploratory.</p><p><strong>Conclusion: </strong>At ≥ 12 months, neurological scores were generally higher than baseline, although the magnitude of change varied. Longer symptom duration was associated with poorer recovery in several patient-reported and functional domains, while improvement was also reported after prolonged symptoms.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}